Minimal Standards of Fitness for Civilian Employees, Volunteers, and Contractor's Employees for Deployment to the CENTCOM AOR

(1) The minimal standards of fitness for deployment, including a list of medical conditions that usually preclude are listed in (6) below. The list of conditions is not comprehensive;
there are many more conditions that could be cause to deny medical clearance for deployment. Possession of one or more of the conditions listed in this chapter does not automatically mean
that the individual may not deploy. Rather, it imposes the requirement to obtain a knowledgeable physician's opinion as to the deployable status of the individual. ― Medical conditions as used
here also include those health conditions usually referred to as dental, oral, psychological and/or emotional conditions.

(2) The medical authority evaluating a member for deployment must bear in mind the following facts:

(a) Medical care in-theater is generally not as robust and amply available as that in the continental U.S. If maintaining an individual‘s health requires frequent or intense medical management and/or specialist care or ancillary services, they should not deploy.

(b) The individual must take all required medications and medical supplies with him or her. Replacements must be available in the theater formulary.

(c) Medical maintenance support for personal medical devices (e.g., TENS, CPAP) is not available. Common household electrical current (110VAC) is not universally or consistently available.

(d) In addition to the individual‘s duties, the environmental conditions may include extremes of temperature, physiologic demand (water, mineral, salt, and heat management), and poor air quality (especially particulates), while the operating conditions may impose extremes of diet (to include fat, salt, and caloric levels), discomfort, sleep deprivation, emotional stress, and circadian disruption. If maintaining an individual‘s health requires avoidance of these extremes or excursions, she/he should not deploy.

(3) The above rules and facts should allow the evaluating medical authority to make qualified judgments as to whether a condition should be approved. Any medical condition that markedly impairs an individual‘s
daily function is potential grounds for disapproval. Evaluation of functional capacity to determine fitness in conditions of physiologic demand is encouraged as needed to make a decision, such as graded exercise
testing when there is coronary artery disease or significant risk thereof. The evaluating care provider should pay special attention to cardiovascular, pulmonary, orthopedic, neurological, endocrine,
dermatological, psychological, visual, and auditory conditions which may present hazard to the individual or others and/or preclude performing the related functional requirements in the deployed setting.
Also, the amount of medications being taken and their suitability and availability in the theater environment must be considered.

(4) Nothing in this guidance document should be construed as authorizing use of defense health program or military health system resources for such evaluations where it is not elsewhere previously authorized.
Generally, defense health program or military health system resources are not authorized for the purpose of pre-deployment or travel medicine evaluations for contractors’ employees. Local command legal and
resource management authorities should be consulted for questions on this matter.

(a) All personnel (uniformed service members, government civilian employees, volunteers, and contractor employees) deploying to theater must be medically and psychologically fit for deployment.
Fitness specifically includes the ability to accomplish the tasks and duties unique to a particular operation, and ability to tolerate the environmental and operational conditions of the deployed
location.

(b) Personnel who have existing medical conditions may deploy if all of the following conditions are met:

1. The condition(s) is/are not of such a nature that an unexpected worsening is likely to have a medically grave outcome.

2. The condition(s) is/are stable; that is, currently under medical care, and reasonably anticipated by the pre-deployment medical evaluator not to worsen during the deployment under available care in theater, in light of physical, physiological, psychological and nutritional impacts and effects of the duties and location.

3. Any required ongoing health care or medications must be immediately available in-theater within the military health system, and have no special handling, storage or other requirements (e.g., cold chain, electrical power required).

4. No need for significant duty limitation or restriction is imposed by the medical condition. (The nature of the accommodation must be considered. The theater (Component/JTF) surgeon is the appropriate authority to evaluate the suitability of the individual vis-à-vis needed limitations in theater.)

(6) Documented medical conditions usually precluding medical clearance. While a list of all possible diagnoses and their severity that should not be approved would be too expansive to list here, the following
conditions, in general, should usually not be approved. The medical evaluator must carefully consider whether there is any question whether the climate, the altitude, the nature of available food and housing,
the availability of medical, behavioral health, dental, and surgical services, or whether other environmental and operational factors may be hazardous to the deploying person's health because of a known physical
condition. Usually, medical clearance to deploy for persons with any of the following documented medical conditions should be granted only after consultation with theater medical authority. The theater medical
authority can determine if adequate treatment facilities and specialist support is available at the duty station.

(a) Conditions resulting in inability to wear personal protective equipment, including protective mask, ballistic helmet, body armor, and chemical/biological protective garments, regardless of the nature of the condition that causes the inability.

(b) Conditions which prohibit required theater immunizations (other than smallpox & anthrax per current guidance) or medications (such as antimalarials and other chemoprophylactic antibiotics).

(c) Conditions or current medical treatment or medications that contraindicate or preclude the use of chemical and biological protectives and antidotes, including oximes (2PAM-chloride), pyridostigmine bromide, atropine or granisetron.

(d) Diabetes mellitus, Type I or II, on pharmacological therapy.

(e) Symptomatic coronary artery disease, or with myocardial infarction within one year prior to deployment, or within six months of coronary artery bypass graft, coronary artery angioplasty, or stenting.

(f) Dysrhythmias or arrythmias, either symptomatic or requiring medical or electro-physiologic control.

(l) New-onset (less than one year) seizure disorder, or seizure within one year prior to deployment.

(m) History of heat stroke

(n) Meniere's disease or other vertiginous/motion sickness disorder, unless well controlled on medications available in theater

(o) Recurrent syncope

(p) Ataxias

(q) New diagnosis (less than one year) of mood disorder, thought disorder, anxiety, somatoform, or dissociative disorder, or personality disorder with mood or thought manifestations.

(r) HIV antibody positivity, confirmed, with the presence of progressive clinical illness or immunological deficiency. (Host Nation requirements for notification of HIV-positive personnel in country will be observed.) The theater surgeon should be consulted in all instances of HIV seropositivity before medical clearance for deployment.